<!--CONTENT SECTION START-->
<div id="wrap">
    <div class="content">                    
        <form name="signupFrm" id="signupFrm" method="POST" action="">
                <table>
                    <tr align="center">
                        <td width="100">                        
                <table cellpadding="2" cellspacing="2">
                    
                    <tr>
                        <h1 class=""  align="center" style="font-size: 20px">Register Here</h1>
                    <tr >
                        <td>First Name:</td>
                        <td><input type="text" value="<?php echo $_POST['firstName'];?>" name="firstName" id="firstName" size="27"</td>
                    </tr>
                    
                    <tr>
                        <td>Last Name:</td>
                        <td><input type="text"  value="<?php echo $_POST['lastName'];?>" name="lastName" id="lastName" size="27"</td>
                    </tr>
                   
		    <tr> 
                        <td>Your Email:</td>
                        <td><input type="text"  value="<?php echo $_POST['email'];?>" name="email" size="27"/></td>
                    </tr>                                                                                                                                                                                                    

                    <tr>
                         <td>Re-enter Email:</td>                                                               
                         <td ><input type="text" name="conf_email" size="27"/></td>                                                                                       
                    </tr>                                                                   
                    
                    <tr>
                         <td>New Password:</td>
                         <td><input type="text" name="password"  value="<?php echo $_POST['password'];?>" size="27"/></td>
                    </tr>

                    <tr>
                         <td>Re_enter Password:</td>
                         <td><input type="text" name="cnf_password" size="27"/></td>
                    </tr>

                    <tr>
                         <td>Birthday:</td>
                         <td>
                             <select name="day" id="day">
                             <option value="0">Day:</option>
                             <option value="1">1</option><option value="2">2</option><option value="3">3</option><option value="4">4</option><option value="5">5</option><option value="6">6</option><option value="7">7</option><option value="8">8</option><option value="9">9</option><option value="10">10</option><option value="11">11</option><option value="12">12</option><option value="13">13</option><option value="14">14</option><option value="15">15</option><option value="16">16</option><option value="17">17</option><option value="18">18</option><option value="19">19</option><option value="20">20</option><option value="21">21</option><option value="22">22</option><option value="23">23</option><option value="24">24</option><option value="25">25</option><option value="26">26</option><option value="27">27</option><option value="28">28</option><option value="29">29</option><option value="30">30</option><option value="31">31</option>
                             </select>
                                                                                        
                             <select name="month" id="month">
                             <option value="0">Month:</option>
                             <option value="1">Jan</option><option value="2">Feb</option><option value="3">Mar</option><option value="4">Apr</option><option value="5">May</option><option value="6">Jun</option><option value="7">Jul</option><option value="8">Aug</option><option value="9">Sep</option><option value="10">Oct</option><option value="11">Nov</option><option value="12">Dec</option>
                             </select>
                                                                                        
                             <select name="year" id="year">
                             <option value="0">Year:</option>
                             <option value="2012">2012</option><option value="2011">2011</option><option value="2010">2010</option><option value="2009">2009</option><option value="2008">2008</option><option value="2007">2007</option><option value="2006">2006</option><option value="2005">2005</option><option value="2004">2004</option><option value="2003">2003</option><option value="2002">2002</option><option value="2001">2001</option><option value="2000">2000</option><option value="1999">1999</option><option value="1998">1998</option><option value="1997">1997</option><option value="1996">1996</option><option value="1995">1995</option><option value="1994">1994</option><option value="1993">1993</option><option value="1992">1992</option><option value="1991">1991</option><option value="1990">1990</option>
                             </select>
                          </td>
                      </tr>


                      <tr>
                          <td>Gender: </td>
                          <td>
                          <select name="gender" id="gender"/>
                          <option value="M">Male</option><option value="F">Female</option>
                          </td>
                      </tr>


                      <tr>
                          <td>City:</td>
                          <td><input type="city" name="city" size="27"/> </td>
                      </tr>

                                                         
                      <tr>
                          <td> Favourite quote:</td>
                          <td> <input type="fquote" name="fquote" size="27"/></td>											   
                      </tr>

                      <tr>
                          <td>Language: </td>
                          <td> <input type="lang" name="lang" size="27"/></td>
                      </tr>

                      <tr>
                           <td>Religious View: </td>
                           <td> <input type="rview" name="rview" size="27"/></td>
                      </tr>
                      
                      <tr>
                           <td>Address line 1: </td>
                           <td> <input type="add" name="add1" size="27"/></td>
                      </tr>
                      <tr>
                           <td>Address line 2: </td>
                           <td> <input type="add" name="add2" size="27"/></td>
                      </tr>
                       
                      <tr>
                      
                           <td>Contact: </td>
                           <td> <input type="cont" name="cont" size="27"/> </td>
                      </tr>

                      <tr>
                           <td align="left">
                              <label for="captcha">Security Check: </label>
                              <form id="frmCaptcha" name="frmCaptcha"></form>
                           </td>
                           <td>
                                <input id="txtCaptcha" type="text" name="txtCaptcha" value="" maxlength="10" size="27" />
                           </td>
                         <tr>
                           <td>&nbsp;</td>
                           <td>
                                <input name="ent" id="ent" type="text" value="" size="27"/>
                           </td>
                         </tr>
                       </tr>

                       <tr>
                            <td>&nbsp;</td>
                            <td>
                                 <input id="btnCaptcha" type="button" value="Verify" name="btnCaptcha" onclick="getParam(document.frmCaptcha)"/>
                            </td>
                                                                                            
                        </tr>
                        
                        <tr>
                            <td>
                                <input type="submit" name="signup" value="Register">
                            </td>
                                
                        </tr>
                 
                </table>
               
                </td>
             </tr>
         </table>
        </form>
        <div class="clr"></div>

    </div>

</div>

<!--CONTENT SECTION END-->